Southeastern North Carolina is a rural area with concentrations of poverty and a large proportion of African-American residents. Within the nine-county service area of the New Hanover Health network are almost 170,000 African-American residents. African-Americans in North Carolina have higher mortality rates, compared with whites, for cancers of the uterine cervix, lung and bronchus, prostate, larynx, oral cavity and pharynx, breast, colon and rectum, and soft tissue. Participation by African-American cancer patients in federally sponsored radiation oncology group clinical trials has the potential to articulate more clearly the factors that contribute to these disparities. Our goal is to increase accrual of African-American cancer patients to radiation therapy group clinical trials through the following: 1) Developing a collaborative partnership with an experienced academic institution that can provide continuing education, consultation, and training in the areas of radiation oncology treatment and research; 2) Identifying and addressing the local factors that inhibit participation in radiation clinical trials; and 3) Developing mechanisms to communicate with patients and providers in surrounding, rural areas to provide consultation and facilitate appropriate referrals for radiation trials. We have developed three pilot studies (the response to the local factors aim, above) to address the following research questions: 1) How does the administration of amifostine during 3D conformal and intensity modulated radiation therapy for head and neck cancer interact with health habits and environmental factors in treatment completion, quality of life, and patient satisfaction with treatment; 2) How does multimodality therapy, including high-dose thoracic RT, chemotherapy, and ZD1839 as a potential radiosensitizer, for locally advanced non-small cell lung cancer yield tolerance and quality of life outcomes that differ by race; 3) How do cognitive and psychosocial factors, namely, relationships with health care providers, religious beliefs, and predicted quality of life, influence the decision of prostate and breast cancer patients to seek, begin, and complete radiation treatment? This project will permit us to contribute to the advancement of medical knowledge and medical practice that will eventually lead to the reduction or elimination of racial disparities in cancer outcomes.